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Obamacare's Future? 3 Things to Expect in 2014

The answer to that question depends largely upon whom you ask. Rep. Nancy Pelosi, D-Calif., thinks that the future for Affordable Care Act will be "a glorious thing." Sen. Ted Cruz, R-Texas, says that millions of Americans risk losing their current health insurance along with increasing numbers of doctors and hospitals opting out of Obamacare.

Regardless of which view proves to be more accurate, there are some aspects about the future of Obamacare that seem more likely than not. Here are three things to expect in 2014.

Rep. Nancy Pelosi, D-Calif. (Source: Wikimedia Commons )

1. More delaysDelays have become standard fare for the implementation of Obamacare thus far. Don't expect 2014 to be any different. What's most likely to be delayed in the months ahead?

One possibility is an extension of the open enrollment period past the current March 30 cut-off. Health and Human Services Secretary Kathleen Sebelius recently stated that she doesn't anticipate any more delays in the implementation of the health reform legislation. However, if enrollment numbers remain well below projections by early March, it wouldn't be surprising if the White House pushes the deadline back.

The tax penalty for failing to obtain health insurance looks like another prime candidate for a delay. President Obama already temporarily suspended the health reform law's individual mandate for individuals who had their insurance canceled in 2013. Pressure could quite possibly build in 2014 to make this delay applicable for more Americans.

2. Insurer challengesNo health insurer is more closely linked with Obamacare than WellPoint (NYSE: ANTM) . If you judged the probability of success for health reform solely by how well the big insurance company's stock performed, the smart money would be on big wins in 2014. WellPoint's shares soared nearly 52% last year.

However, much of WellPoint's success stems from the company's significant presence in Medicaid. Many of the other smaller insurers participating in the Obamacare exchanges can't make the same claim. Even with the higher enrollment from late December, far fewer Americans have signed up for health insurance than expected. Those numbers need to pick up tremendously for insurers to avoid incurring losses.

A big part of the problem is that the sickest individuals could be the ones most likely to enroll. Concerns about this led UnitedHealth Group (NYSE: UNH) , the nation's largest health insurer, to opt out of participation in most state health insurance exchanges. UnitedHealth CEO Stephen Hemsley voiced worries that the first wave of enrollees would be less healthy -- and therefore more costly.

The clearest sign that insurers are facing stiff challenges in 2014 would be a push by the federal government to modify the risk corridors established to help prevent companies from losing too much from insuring sicker Americans. The Obama administration has already tweaked the risk corridor program to give financial incentives to health insurers for renewing plans that were canceled because they didn't meet Obamacare minimum benefit standards. More actions along those lines means that things aren't looking good for health insurers who jumped on the Obamacare bandwagon.

3. Big court decisionsIf you think the Affordable Care Act is the settled law of the land, think again. Multiple challenges to the health reform act are working their way through the U.S. judicial system.

The Supreme Court will hear two key cases in 2014 about the Obamacare requirement that employers cover birth control and other reproductive health services. Privately held Hobby Lobby, the plaintiff in one of those cases, maintains that the law's mandate that it pay for certain birth control drugs that prevent human embryos from being implanted in the womb violates the company owners' religious liberty.

Other lawsuits that have the potential to greatly undermine Obamacare won't be heard by the Supreme Court in its upcoming session. It won't be a surprise, though, if the justices decide later in 2014 to include one or more of these cases on its docket for next year.

The premise of these cases is that the IRS overstepped its bounds in allowing subsidies to be provided for individuals in states that don't operate their own health insurance exchanges. If the plaintiffs ultimately prevail, this could make the Obamacare individual mandate unravel -- since 36 states don't operate their own exchanges.

Glorious or inglorious?Events unfolding in 2014 will be pivotal in whether Obamacare becomes the glorious thing anticipated by Rep. Pelosi or encounters a far more inglorious fate. One industry's fortunes particularly ride on the outcome: hospitals.

Hospital stocks surged as the date for implementation of Obamacare drew nearer. Shares of HCA Holdings (NYSE: HCA) and Tenet Healthcare (NYSE: THC) more than doubled from January 2012 through October 2013. Community Health Systems (NYSE: CYH) soared 145% during the same period.

However, the shares of all three companies have plateaued or faded as Obamacare's troubles became evident over the last three months. A successful open enrollment could recharge these stocks. More problems, though, could result in hospitals giving up some of those big gains.

We can't know what will happen in the new year for sure. Yogi Berra, though, hit the nail on the head with his observation: The future ain't what it used to be.

How will Obamacare impact you in 2014?Confused about how health reform affects you and your finances? Obamacare seems complex, but it doesn't have to be. In only minutes, you can learn the critical facts you need to know in a special free report called Everything You Need to Know About Obamacare. This FREE guide contains the key information and money-making advice that every American must know for the new year. Please click here to access your free copy.

Comments from our Foolish Readers

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The future is that it will be repealed and replaced within the next year or so. The people will be so angry about higher premiums, higher deductibles, higher taxes, less doctors, lower time with the doctors, There will be increase visits in the emergency room and higher prescription copays. The American people will start protesting louder and more often with a big rally scheduled for DC on May 26th and other rallies. I see the democrats to lose big in November and then lose in 2016 because of all the lies and the pain cost by this awful law.

you can expect millions of americans loosing their jobs due to obama care high insurance cost. 2nd,loosing your doctor .3rd, loosing your medical insurance. but fear not, miilions of americans whom are to lazy to find a job and work for a living will now have health insurance at the tax payers exspence for little or no cost.

Mr. President, I can no longer defend Obamacare in light of evidence that your administration has ignored pleas from professional health care organizations to put in place updated regulations for insurance companies to replace flawed regulations that have been in effect since August, 2012. Please take note of the following link: http://www.mothering.com/community/t/1387804/breastfeeding-a...

The cut off date can't be changed. It's set so insurers can use the data from the people who enrolled in the current year to set the rates for next year.

As it is I think insurers are in panic mode. If all they get is unhealthy older people the law will cost them a fortune. If the losses look too big I expect to see some pull out of the market. If that happens expect the law to collapse.

A $2 fee per policy for the Patient Centered Outcomes Research Institute.

Insurers also pay a 3.5% user fee to sell medical plans on the HealthCare.gov site.

American taxpayers must also pay a 2.3% medical-device tax.

"Income and payroll taxes go up to fuel the enormous machinery that Obamacare has become. When you pay medical expenses out-of-pocket you should get an income-tax deduction. Americans may be used to deducting medical expenses that exceed 7.5% of their annual income. But now they must eat another 2.5%. The threshold jumps to 10% under the Affordable Care Act. That costs taxpayers about $15 billion over 10 years."

"Then there’s the new Medicare tax. Under the Affordable Care Act, individual tax filers earning more than $200,000 and families earning more than $250,000 pay a 0.9% Medicare surtax on top of the existing 1.45% Medicare payroll tax. Then to cap off all this good news, they pay an extra 3.8% Medicare tax on unearned income, such as investment dividends, rental income and capital gains. If you sold your house in 2012, you paid a 15% capital gain tax. Now figure 23.8%."

Tremendous financial pressure will be placed on physician groups and hospitals. Patients will be paying out of pocket for most care because of the high deductible plans. Eventually the policies will come down in price as insurance is paying less for everyday care. Insurance will cover wellness and catastrophic events. In short term, patients will wonder why they decided to pay for insurance. We need to reinvent hospitals to reduce cost and make care affordable to cover everyone.

Aca is going nowhere! Republicans could not look more angry considering the democrats have FINALLY brought healthcare for millions. Move on republicans. You lost this debate just like most elections. Ha! It doesn't matter what goes wrong this year with the Ada. It will pan out and voters will continue to vote d! Can't wait for my girl Hilary!!!

Obama is happy, Insurers are happy, Democrats are happy (for now). 2014 will bring such a disaster to our healthcare system, all will be looking for the back door. Millions of people now think they have coverage. Some do, many don't. Premiums have not been paid, coverage has not started for so many. Hospitals and healthcare providers will have to clean up the mess with verifying coverage and trying to file claims. People will be so angry when they do not receive what they have been promised, March will begin this dark time for all of us. Be ready!!

I`m never getting over the fact that this boondoggle," make up the rules as you go", Ponzi scheme, Obamacare, was sold to Americans with LIES, and DECEIT !! Obama, Queen Nancy, Harry Reid, etc., are all guilty. Maybe this is acceptable to the brainwashed Obama drones, not me.

Just say no. ObamaCare made me lose my insurance. Unless I need something drastic like an organ transplant, the insurance (to comply) will be a few thousand more per year than what I was paying. Even then it comes with higher deductibles. So, what is the point? Just so that Sandra Fluke can get her birth control pills and "morning after" pills for free?

Everybody, just say no. Maybe if Ms. Fluke said that more often we wouldn't need to buy her all those pills, lol.

Expect more lies, more Americans dying or imprisoned abroad, more surveillance, more multi million dollar vacations, more custom made dresses for Michelle, more Obamacare glitches, more broken promises, more Obama insults to America's allies, more Obama outreaches to America's enemies and maybe an Obama world war, if Syria gave us a glimpse into our future. All with Obama smiling, and laughing it all off on late night comedy talk shows, while reading his teleprompter scripts.

The pending court challenges are the least important reason that Obamacare is not "the settled law of the land". The fact that the law was forced through Congress without a single Republican vote puts a gigantic bullseye on the ACA. As soon a Republicans can take enough seats in Congress to shoot it down then Obamacare is dead. 60 total seats in the Senate would be enough if a Republican President sits in the White House. Otherwise, two thirds of the Senate would be enough. Regardless, Obamacare will eventually be repealed.

Obamacrap was never designed to work it was designed to CONTROL and HARM the American people and COLLASPE the U. S. $$$$$$ and while Americans are HURTING and DISTRACTED by obamacrap, Obama will be continuing to bring more harm and destruction to America.

Obama is a traitor and a threat to America and our national security and has put in place through his traitor czars and nominees people that ARE and WILL bring HARM to us. Go to THE OBAMA FILE / CZARS and also INVESTIGATING OBAMA.

Obama is a George Soros puppet along with most of his czars and nominees. George Soros is a COMMUNIST ATHEIST who is destroying America through Obama and his traitor democrats and probably some traitor republicans. Go to CENTER FOR AMERICAN PROGRESS / THE SOROS FILES. All of these people share the same values and agenda as SOROS, and some of them have worked for Soros before.

Jeh Johnson in homeland ( and one of Obama's ) is smuggling illegal children into the US and uniting them with their illegal parents. Instead of securing our borders he is HELPING THEM look at Obama's immigration bill. And Cass Sunstein who is Obama's #23 czar is a Jewish Atheist that in a 2007 speech at Harvard CALLED FOR BANNING HUNTING IN THE U.S. Look at Obama's gun control. Obama has said "Cass is not only a valued advisor, he is a dear friend". These are just a few of the things that Obama , his czars and nominees have in store for America.

As long as Obama remains in office the more harm and destruction that he will continue to bring to America . Can America survive until 2016 with this traitor and all of his traitor czars and nominees in office ? Wake up Washington and get Obama out NOW !!!! obamacrap was just the beginning of the destruction to come. As Americans are distracted by Obamacrap, Obama will be bringing more HARM to America

It is past time to do away with Obama care. It will ruin this country. We cannot afford this idiot idea of health care. This president has screwed this country to death. We all will pay the price until there is no more left. It is hard to pay the bills now just wait until this thing is on our backs.

Sending report...

Keith began writing for the Fool in 2012 and focuses primarily on healthcare investing topics. His background includes serving in management and consulting for the healthcare technology, health insurance, medical device, and pharmacy benefits management industries.